Inhaled Nitric Oxide/INOpulse DS for Pulmonary Arterial Hypertension (PAH)
NCT ID: NCT01457781
Last Updated: 2023-02-27
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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COMPLETED
PHASE2
80 participants
INTERVENTIONAL
2012-04-30
2016-07-31
Brief Summary
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Detailed Description
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There are two parts to this study. In Part 1 (week 0 to week 16), the objectives are to determine the safety, tolerability, efficacy, and exploratory objectives of two different doses of iNO delivered by a pulsed delivery device in symptomatic subjects with PAH who remain symptomatic due to PAH on approved PAH monotherapy or combination approved PAH therapy. In Part 2 (week 17 to end of study Part 2 \[EOS Part 2\]), the objective is to compile data on the long-term effects of iNO on safety, tolerability, clinical and hemodynamic measures.
Conditions
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Study Design
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RANDOMIZED
CROSSOVER
TREATMENT
QUADRUPLE
Study Groups
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0.025 mg inhaled nitric oxide
Inhaled nitric oxide (iNO) 0.025 mg/kg IBW/hr for up to 24 hours/day x 16 weeks (3.0 mg/L \[2440 ppm\] NO mini-cylinder; change q 24 hours) delivered via INOpulse® DS delivery device.
Inhaled Nitric Oxide 0.025 mg/kg IBW/hr delivered via INOpulse DS Device
Cohort 1: 0.025 mg/kg IBW/hr for up to 24 hours/day x 16 weeks (3.0 mg/L \[2440 ppm\] NO mini-cylinder; change q 24 hours) delivered via INOpulse DS Device and INOpulse DS nasal cannula
0.075 mg inhaled nitric oxide
Inhaled nitric oxide (iNO) 0.075 mg/kg IBW/hr for up to 24 hours/day x 16 weeks (6.0 mg/L \[4880 ppm\] NO mini-cylinder; change q 24 hours) delivered via INOpulse® DS delivery device.
Inhaled nitric oxide 0.075 mg/kg IBW/hr delivered via INOpulse DS Device
Cohort 2: 0.075 mg/kg IBW/hr for up to 24 hours/day x 16 weeks (6.0 mg/L \[4880 ppm\] NO mini-cylinder; change q 24 hours) delivered via INOpulse DS Device and INOpulse DS nasal cannula
placebo
Placebo 0.075 mg/kg IBW/hr for up to 24 hours/day x 16 weeks\* (99.999% Nitrogen \[N2\] mini-cylinder; change q 24 hours) delivered via INOpulse® DS delivery device.
Placebo delivered via INOpulse DS Device
Placebo 0.075 mg/kg IBW/hr for up to 24 hours/day x 16 weeks (Nitrogen N2, 99.999%) delivered via INOpulse DS Device and INOpulse DS nasal cannula
Interventions
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Inhaled Nitric Oxide 0.025 mg/kg IBW/hr delivered via INOpulse DS Device
Cohort 1: 0.025 mg/kg IBW/hr for up to 24 hours/day x 16 weeks (3.0 mg/L \[2440 ppm\] NO mini-cylinder; change q 24 hours) delivered via INOpulse DS Device and INOpulse DS nasal cannula
Placebo delivered via INOpulse DS Device
Placebo 0.075 mg/kg IBW/hr for up to 24 hours/day x 16 weeks (Nitrogen N2, 99.999%) delivered via INOpulse DS Device and INOpulse DS nasal cannula
Inhaled nitric oxide 0.075 mg/kg IBW/hr delivered via INOpulse DS Device
Cohort 2: 0.075 mg/kg IBW/hr for up to 24 hours/day x 16 weeks (6.0 mg/L \[4880 ppm\] NO mini-cylinder; change q 24 hours) delivered via INOpulse DS Device and INOpulse DS nasal cannula
Eligibility Criteria
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Inclusion Criteria
2. A confirmed diagnosis of Pulmonary Hypertension Group 1 (PAH) who have either idiopathic PAH (IPAH), heritable PAH, anorexigen-induced PAH, associated PAH (APAH) with connective tissue disease (CTD), APAH with repaired simple congenital systemic to pulmonary shunt (i.e., atrial septal defect \[ASD\], ventricular septal defect \[VSD\] and/or patent ductus arteriosus \[PDA\]; complete repair at least 1 year prior to Screening) or APAH with human immunodeficiency virus (HIV)
3. Confirmation of PAH diagnosis at the time of Baseline RHC according to the following definition: mPAP ≥ 25 mmHg at rest, with a concomitant mean pulmonary capillary wedge pressure (mPCWP), mean left atrial pressure (mLAP), or left ventricular end diastolic pressure (LVEDP) ≤ 15 mmHg and a PVR ≥ 240 dynes.sec/cm-5
4. 6MWD at least 100 meters and no greater than 450 meters
5. The subject is receiving at least one approved PAH therapy and is clinically symptomatic from PAH (e.g., onset or increased dyspnea on exertion, dizziness, near-syncope, syncope, chest pain or peripheral edema)
6. Background PAH medication doses (including calcium channel blockade if being used to treat PAH) must be stable for at least 12 weeks prior to Screening
7. If on background conventional therapy (e.g., digoxin, diuretics, supplemental oxygen, anticoagulation), it must have been started at least 30 days prior to Screening and be on a stable dose for at least 30 days except for anticoagulation dose
10. Age between 16 and 80 years (inclusive)
11. Male height ≤ 200 cm (6'7") or Female height ≤ 210 cm (6'11")
12. Subjects are willing and considered in the judgment of the Investigator able to use the INOpulse DS device continuously for up to 24 hours per day
13. Females of childbearing potential must have a negative pre-treatment serum pregnancy test and must be on a reliable method of contraception (including double protection if appropriate, e.g., for subjects concurrently treated with bosentan therapy)
4. PAH associated with significant venous or capillary involvement (PCWP \> 15 mmHg), known pulmonary veno-occlusive disease, or pulmonary capillary hemangiomatosis
5. Any subject with WHO PH Groups 2, 3, 4 or 5
6. Left ventricular systolic dysfunction, i.e., left ventricular ejection fraction (LVEF) \< 40% or left ventricular shortening fraction (LVSF) \< 22%
7. Left ventricular diastolic dysfunction, i.e., PCWP \> 15 mmHg at rest or with exercise, acute volume loading or pharmacologic testing
8. History of clinically significant cardiomyopathy or valvular heart disease (i.e., moderate or greater aortic insufficiency; moderate or greater aortic stenosis; or moderate or greater mitral valve disease)
9. Clinically significant cardiac ischemic disease requiring use of nitrates, or hospital admission for acute coronary syndrome or intervention (percutaneous coronary intervention, coronary artery stent, coronary artery bypass surgery) within the past 90 days
10. Down syndrome
11. Any subject who develops a PCWP \> 20 mmHg during AVT with iNO
12. Systemic hypertension defined as systolic blood pressure (SBP) \> 160 mmHg and/or diastolic blood pressure (DBP) \> 100 mmHg persistent at Screening after a period of rest (treated or untreated)
13. Systemic hypotension defined as SBP \< 90 mmHg persistent at Screening after a period of rest
14. Moderate to severe obstructive lung disease defined as both a forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) \< 70% and FEV1 \< 65% of predicted value (bronchodilator administration prior to testing is optional; the test should be done within 3 years for all subjects with the exception of APAH/CTD which needs to be done within 6 months prior to Screening)
15. Moderate to severe restrictive lung disease: total lung capacity (TLC) \< 60% of predicted; if TLC 60% to 70% predicted, a high resolution CT scan showing diffuse disease or more than mild patchy disease (done within 3 years for all subjects with the exception of APAH/CTD which needs to be done within 6 months prior to Screening)
16. Moderate to severe hepatic impairment, i.e., Child-Pugh Class B or C
17. Estimated creatinine clearance \< 30 mL/min (Cockcroft-Gault formula)
18. Hemoglobin \< 10 gm/dL at Screening or Baseline
19. Acute or chronic physical impairment (other than dyspnea due to PAH) that would limit the ability to comply with study procedures or adherence to therapy, including carrying and wearing the INOpulse device per study protocol
20. Pregnant or breast-feeding at Screening
21. Administered L-arginine within 30 days prior to Screening
22. Known concomitant life-threatening disease with a life expectancy less than 1 year
23. Recently started (\< 12 weeks prior to randomization) or planned cardiopulmonary rehabilitation program to start within the 16 week controlled study
24. Atrial septostomy within 3 months of randomization
25. Any subject with PAH who is treatment naïve or receiving any unapproved therapy as their only PAH treatment (including calcium channel blockade if the calcium channel blockade is the only treatment for the PAH)
26. Any subject who requires the use of a continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), or other positive pressure devices to treat obstructive sleep apnea
27. Medical problem(s) likely to preclude completion of Part 1
28. Use of investigational drugs or devices within 30 days prior to enrollment into the study (other than acute vasodilator testing with iNO or IV epoprostenol)
29. Any underlying medical or psychiatric condition that, in the opinion of the Investigator, makes the subject an unsuitable candidate for the study
30. Any condition other than the subject's PAH that, in that opinion of the investigator, affects their ability to perform the 6MWT
31. Refusal to follow the protocol, including the two RHCs in Part 1 and one RHC in Part 2
32. Unable to travel to the investigational site for all required study visits and for all additional visits per the judgment of the Investigator or Sponsor
Exclusion Criteria
2. PAH associated with portal hypertension, untreated thyroid disorders, glycogen storage disease, Gaucher's disease, hereditary hemorrhagic telangiectasia, hemoglobinopathies, myeloproliferative disorders or splenectomy
16 Years
80 Years
ALL
No
Sponsors
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Bellerophon Pulse Technologies
INDUSTRY
Responsible Party
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Principal Investigators
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Ashika Ahmed, MD
Role: STUDY_DIRECTOR
Bellerophon Therapeutics
Locations
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University of Alabama at Birmingham
Birmingham, Alabama, United States
Arizona Pulmonary Specialists
Phoenix, Arizona, United States
Allianz Research Institute, Inc.
Fountain Valley, California, United States
University of California, San Francisco-Fresno
Fresno, California, United States
West Los Angeles VA Healthcare Center
Los Angeles, California, United States
David Geffen School of Medicine at UCLA
Los Angeles, California, United States
Los Angeles Biomedical Research Institute at Harbor-UCLA Med Ctr
Torrance, California, United States
Children's Hospital Colorado
Aurora, Colorado, United States
University of Colorado Denver
Aurora, Colorado, United States
South Denver Cardiology Associates P.C.
Littleton, Colorado, United States
Christiana Care Health System
Newark, Delaware, United States
University of Florida College of Medicine
Jacksonville, Florida, United States
Cleveland Clinic Florida
Weston, Florida, United States
Emory University Hospital-Emory Clinic
Atlanta, Georgia, United States
University of Iowa Hospitals & Clinics
Iowa City, Iowa, United States
University of Kansas Medical Center
Kansas City, Kansas, United States
University of Kentucky Gill Heart
Lexington, Kentucky, United States
Kentuckiana Pulmonary Associates
Louisville, Kentucky, United States
LSUHSC-New Orleans
New Orleans, Louisiana, United States
University of Maryland Medical Center
Baltimore, Maryland, United States
Tufts Medical Center
Boston, Massachusetts, United States
Boston University Medical Center/Boston University School of Medicine
Boston, Massachusetts, United States
University of Michigan
Ann Arbor, Michigan, United States
University of Minnesota, Cardiovascular Division
Minneapolis, Minnesota, United States
Mayo Clinic
Rochester, Minnesota, United States
Washington University School of Medicine
St Louis, Missouri, United States
Dartmouth-Hitchcock Medical Center
Lebanon, New Hampshire, United States
University of Medicine and Dentistry of NJ
Newark, New Jersey, United States
Barnabas Health Newark Beth Israel Medical Center
Newark, New Jersey, United States
Beth Israel Medical Center
New York, New York, United States
Weill Cornell Medical Center
New York, New York, United States
Montefiore Medical Center
The Bronx, New York, United States
Duke University Medical Center
Durham, North Carolina, United States
UC Health/University of Cincinnati
Cincinnati, Ohio, United States
University Hospitals Case Medical Center
Cleveland, Ohio, United States
Cleveland Clinic
Cleveland, Ohio, United States
Ohio State University Martha Morehouse Medical Pavillion
Columbus, Ohio, United States
South Oklahoma Heart Research LLC
Oklahoma City, Oklahoma, United States
Legacy Medical Group - Pulmonary Clinic
Portland, Oregon, United States
Temple University Hospital
Philadelphia, Pennsylvania, United States
Allegheny Singer Research Institute/Allegheny General Hospital
Pittsburgh, Pennsylvania, United States
Rhode Island Hospital
Providence, Rhode Island, United States
Sioux Falls Cardiovascular PC
Sioux Falls, South Dakota, United States
University of Texas Southwestern Medical Center
Dallas, Texas, United States
Baylor College of Medicine
Houston, Texas, United States
Intermountain Medical Center
Murray, Utah, United States
Aurora St. Luke's Medical Center
Milwaukee, Wisconsin, United States
Peter Lougheed Center
Calgary, Alberta, Canada
ABACUS - University of Alberta Hospitals
Edmonton, Alberta, Canada
London Health Sciences Centre
London, Ontario, Canada
University Health Network - Toronto General Hospital
Toronto, Ontario, Canada
Countries
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Other Identifiers
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IK-7001-PAH-201
Identifier Type: -
Identifier Source: org_study_id
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